Routine inspection·October 4, 2021

Licensing Program Analyst (LPA) Norman Woodridge conducted a Covid-19 Annual Inspection at the facility. Upon arrival, LPA informed Staff (S1) of the purpose of the visit and was granted entry into the facility. LPA met with S1 and discussed the purpose of the inspection. During the inspection, LPA and S1 conducted a tour of the inside and outside of the facility, common areas, resident rooms, garage, and kitchen. LPA observed the following: There were 2 staff and 4 residents present at the facility. Resident rooms were clean and organized. LPA observed a 2-day supply of perishables and a 7-day supply of nonperishables. LPA observed hallways and walkways that were free of obstruction. LPA provided technical assistance regarding temperature checks, documentation, and Covid-19 facemask requirements. LPA and S1 discussed Provider Information Notice 21-38-ASC: Update Guidance for the Use of Masks, Surgical Masks, Respirators Related to Coronavirus Disease 2019 (COVID-19). No deficiencies were noted during the inspection. An exit interview was conducted with S1 and a copy of this report was provided.